Neuro-oncology E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: NIP- Neurology in Practice
• Sprache: Englisch

Seitenzahl: 580

Veröffentlichungsjahr: 2012

Beschreibung

Cancer imposes daunting effects on the nervous system

Brain cancer is one of the most devastating diagnoses a physician can deliver. Cancer of the nervous system can take many different forms. Treatment is specific to the type of malignancy, its location in the nervous system and, increasingly, its molecular characteristics. The challenges manifest further when management choices need to be made, and multidisciplinary approaches are required. Additional complexities arise in children, where the developing neurological system requires more sensitive treatment.

Neuro-oncology unmasks the complexities to provide a straightforward guide to cancers of the nervous system. Following a general approach to diagnosis and treatment, the clinical aspects of specific cancer types in adults and children are explained in practical terms. A final section considers the effect of system cancer on the nervous system and the side effects of treatment.

Clinical in approach, practical in execution, Neuro-oncology will help you diagnose and manage your patients more effectively.

Neurology in Practice

Series Editors
Robert A Gross , MD, PhD, Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
Jonathan W Mink, MD, PhD, Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA

The Neurology in Practice series provides clinical 'in the office' or 'at the bedside' guides to effective patient care for neurologists. The tone is practical, not academic, with authors offering guidance on what might be done and what should be avoided. The books are informed by evidence-based practice and feature:

• Algorithms and guidelines where they are appropriate
• 'Tips and Tricks' boxes – hints on improving outcomes
• 'Caution' warning boxes – hints on avoiding complications
• 'Science Revisited' – quick reminder of the basic science principles
• Summaries of key evidence and suggestions for further reading

Leseprobe

Table of Contents

Cover

Title page

Copyright page

Contributors

Series Foreword

Preface

Acknowledgments

Part I: Overview and General Aspects of Therapy

1 Diagnosis of Brain Tumors: Clinical and Radiographic

Introduction

Clinical diagnosis of brain tumors

Radiographic diagnosis of brain tumors

Conclusions

2 Epidemiology and Etiology

Introduction

Descriptive epidemiology

Analytic epidemiology of risk factors

3 General Aspects of Surgery

Introduction

Goals of surgery

Craniotomy

Postoperative care

Technologic advances in brain tumor surgery

Complications

4 General Approach to Radiation Oncology

Introduction

Radiation biology and physics

The radiation oncologist’s toolbox

Management

Palliation

5 General Aspects of Chemotherapy Including “Biologic Agents”

Introduction

The challenge of drug delivery

The drug development process: a long road

Cytotoxic chemotherapy

Signal transduction pathways, targeted therapy, and personalized medicine

Therapies on the horizon

The future of chemotherapy

Part II: Adult Nervous System Tumors

6 Malignant Gliomas in Adulthood

Introduction

Clinical features

Treatment and outcomes

Monitoring response to therapy

Experimental therapies

Conclusions

7 Low Grade Gliomas and Oligodendrogliomas in Adulthood

Introduction

Definition

Epidemiology

Risk factors

Clinical presentation

Natural history and treatment outcome

Ongoing clinical trials

Post-treatment follow-up

Reproductive issues

Conclusions

8 Ependymomas

Introduction

Epidemiology

Classification

Pathology

Presentation

Physical examination

Diagnosis

Management

Prognosis

Future directions

9 Germ Cell Tumors and Other Pineal Region Tumors

Introduction

Germ cell tumors

Pineal parenchyma tumors

Conclusions

10 Sellar Tumors: Pituitary Adenomas and Craniopharyngiomas

Introduction

Imaging of sellar lesions

Surgical approach to sellar tumors

Pituitary adenomas

Somatotroph adenomas

Craniopharyngioma

Rathke cleft cysts

Complications of trans-sphenoidal surgery

11 Meningiomas

Introduction

Epidemiology

Pathophysiology

Classification

Etiology

Clinical presentation

Imaging

Management

Summary

12 Primary Central Nervous System Lymphomas

Introduction

Epidemiology

Presentation

Diagnosis

Management

Prognosis

13 Intradural Spinal Cord Tumors

Introduction

Epidemiology

Presentation

Imaging

Tumor subtypes

Complications of spinal tumor surgery

Part III: Pediatric Brain Tumors

14 Gliomas in Childhood

Introduction

Biology

High grade gliomas

Low grade glioma

Conclusions

15 Embryonal Tumors

Introduction

Clinical presentation and diagnosis

Aspects of general management

Specific tumor types

16 Infantile Brain Tumors

Introduction

Epidemiology

Initial presentation and evaluation

Medulloblastoma

Primitive neuroectodermal tumors

Ependymoma

Glioma

Atypical teratoid rhabdoid tumor

Choroid plexus tumors

Summary

Part IV: Effects of Systemic Cancer and Treatment on the Nervous System

17 Intracranial Metastases

Epidemiology

Pathogenesis

Pathology

Presentation

Diagnostics

Differential diagnosis

Prognosis

Treatment

18 Spinal Cord Compression

Spinal cord compression

Conclusions

19 Leptomeningeal Metastases

Introduction

Clinical features

Diagnosis

Treatment

Prognosis

Treatment of specific tumors

Summary

20 Immune-Mediated Paraneoplastic Neurologic Disorders: An Overview

Introduction

Pathogenesis and incidence

Diagnosis of the neurologic syndrome and cancer

Detection and significance of paraneoplastic antineuronal antibodies

Frequently encountered paraneoplastic neurologic disorders associated with immune responses

General treatment strategies

21 Neurotoxicity of Radiation Therapy and Chemotherapy

Introduction

CNS toxicity from antineoplastic agents

Chemotherapy-induced peripheral neuropathy

Radiation toxicity

Conclusions

Index

Color Plates

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Library of Congress Cataloging-in-Publication Data

Neuro-oncology / edited by Roger J. Packer, David Schiff. – 1st ed.

p. ; cm.

 Includes bibliographical references and index.

 ISBN 978-0-470-65575-7 (pbk. : alk. paper)

 I. Packer, Roger J., 1951– II. Schiff, David, 1959–

[DNLM: 1. Central Nervous System Neoplasms. WL 358]

616.99'481–dc23

2011044220

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

ISBN 978-1-118-32143-0 (mobi)

ISBN 978-1-118-32144-7 (epub)

ISBN 978-1-118-32145-4 (epdf)

Contributors

Jeffrey C. Allen, MD

Departments of Pediatrics and Neurology

NYU Langone Medical Center

New York, NY, USA

Isabel C. Arrillaga-Romany, MD, PhD

Center for Neuro-Oncology

Dana-Farber/Brigham and Women’s Cancer Center

Boston, MA, USA

Melissa L. Bondy, PhD

Department of Pediatrics

Dan L. Duncan Cancer Center

Baylor College of Medicine

Houston, TX, USA

Marc Chamberlain, MD

Department of Neurology and Neurological Surgery

Fred Hutchinson Cancer Research Center

University of Washington;

Division of Neuro-Oncology

Seattle Cancer Care Alliance

Seattle, WA, USA

Jennifer L. Clarke, MD, MPH

Departments of Neurology and Neurological Surgery

Division of Neuro-Oncology

University of California, San Francisco

San Francisco, CA, USA

Bruce H. Cohen, MD, FAAN

Department of Neurology

Children’s Hospital Medical Center of Akron;

Department of Pediatrics

Northeast Ohio Medical University

Akron, OH, USA

Shlomi Constantini, MD, MSc

Department of Pediatric Neurosurgery

The Gilbert Israeli Neurofibromatosis Center (GINFC)

Dana Children’s Hospital

Tel Aviv Medical Center

Tel Aviv, Israel

Robert Dallapiazza, MD, PhD

Department of Neurological Surgery

University of Virginia Health System

Charlottesville, VA, USA

Josep Dalmau, MD, PhD

Department of Neurology

Hospital Clinic/Institute of Biomedical Investigation (IDIBAPS)

University of Barcelona

Barcelona, Spain

Mark R. Gilbert, MD

Department of Neuro-Oncology

The University of Texas MD Anderson Cancer Center

Houston, TX, USA

Jerome J. Graber, MD, MPH

Department of Neurology and Oncology

Montefiore Medical Center of the Albert Einstein College of Medicine

New York, NY, USA

Sean Grimm, MD

Northwestern University

Chicago, IL, USA

Daphne A. Haas-Kogan, MD

Departments of Radiation Oncology and Neurological Surgery

University of California, San Francisco

San Francisco, CA, USA

Jethro Hu, MD

Johnnie L. Cochran Jr. Brain Tumor Center Departments of Neurology and Neurosurgery

Cedars-Sinai Medical Center

Los Angeles, CA, USA

Michael Ivan, MD

Department of Neurological Surgery

University of California, San Francisco

San Francisco, CA, USA

Kurt A. Jaeckle, MD

Departments of Neurology and Oncology

Mayo Clinic

Jacksonville, FL, USA

John A. Jane Jr., MD

Department of Neurological Surgery

University of Virginia Health System

Charlottesville, VA, USA

Derek R. Johnson, MD

Department of Neurology

Mayo Clinic

Rochester, MN, USA

Thomas J. Kaley, MD

Department of Neurology

Memorial Sloan-Kettering Cancer Center

New York, NY, USA

Santosh Kesari, MD, PhD

Department of Neurosciences

Moores UCSD Cancer Center

University of California San Diego

Health System

La Jolla, CA, USA

Akiva Korn, MMedSci

Department of Pediatric Neurosurgery

Dana Children’s Hospital

Tel Aviv Medical Center

Tel Aviv, Israel

Eudocia Quant Lee, MD, MPH

Center for Neuro-Oncology

Dana-Farber/Brigham and Women’s Cancer Center

Boston, MA, USA

Geneviève Legault, MD

Departments of Pediatrics and Neurology

NYU Langone Medical Center

New York, NY, USA

Zvi Lidar, MD

Spine Unit, Department of Neurosurgery

Tel Aviv Medical Center

Tel Aviv, Israel

Yanhong Liu, PhD

Department of Pediatrics

Dan L. Duncan Cancer Center

Baylor College of Medicine

Houston, TX, USA

Robert G. Louis, MD

Department of Neurological Surgery

University of Virginia Health System

Charlottesville, VA, USA

Melike Mut, MD, PhD

Department of Neurosurgery

Hacettepe University

Ankara, Turkey

Antonio M.P. Omuro, MD

Department of Neurology

Memorial Sloan-Kettering Cancer Center

New York, NY, USA

Roger J. Packer, MD

Center for Neuroscience and Behavioral Medicine

Brain Tumor Institute

Gilbert Neurofibromatosis Institute

Children’s National

Washington, DC, USA

Kanwal P. S. Raghav, MD

Department of Medical Oncology

The University of Texas MD Anderson Cancer Center

Houston, TX, USA

Jeffrey Raizer, MD

Department of Neurology

Northwestern University

Chicago, IL, USA

Alyssa T. Reddy, MD

University of Alabama at Birmingham

Departments of Pediatrics, Neurology and Surgery

Children’s of Alabama

Birmingham, AL, USA

Myrna R. Rosenfeld, MD, PhD

Department of Neurology

Hospital Clinic/Institute of Biomedical Investigation (IDIBAPS)

University of Barcelona

Barcelona, Spain

Michael E. Scheurer, PhD, MPH

Department of Pediatrics

Dan L. Duncan Cancer Center

Baylor College of Medicine

Houston, TX, USA

Mark E. Shaffrey, MD

Department of Neurological Surgery

University of Virginia Health System

Charlottesville, VA, USA

Wendy J. Sherman Sojka, MD

Department of Neurology

Northwestern University

Chicago, IL, USA

Ben Shofty, BMedSci

Department of Pediatric Neurosurgery

The Gilbert Israeli

Neurofibromatosis Center (GINFC)

Dana Children’s Hospital

Tel Aviv Medical Center

Tel Aviv, Israel

Matthew Tate, MD, PhD

Department of Neurological Surgery

University of California, San Francisco

San Francisco, CA, USA

Mary R. Welch, MD

Department of Neurology

Memorial Sloan-Kettering Cancer Center

New York, NY, USA

Patrick Y. Wen, MD

Center for Neuro-Oncology

Dana-Farber/Brigham and Women’s Cancer Center

Boston, MA, USA

Brian J. Williams, MD

Department of Neurological Surgery

University of Virginia Health System

Charlottesville, VA, USA

Jennifer S. Yu, MD, PhD

Department of Radiation Oncology

Department of Stem Cell Biology and Regenerative Medicine

Cleveland Clinic

Cleveland, OH, USA

Series Foreword

The genesis for this book series started with the proposition that, increasingly, physicians want direct, useful information to help them in clinical care. Textbooks, while comprehensive, are useful primarily as detailed reference works but pose challenges for uses at point of care. By contrast, more outline-type references often leave out the “how’s and why’s” – pathophysiology, pharmacology – that form the basis of management decisions. Our goal for this series is to present books, covering most areas of neurology, that provide enough background information for the reader to feel comfortable, but not so much to be overwhelming; and to combine that with practical advice from experts about care, combining the growing evidence base with best practices.

Our series will encompass various aspects of neurology, the topics and specific content chosen to be accessible and useful. Neuro-oncology, by Roger J. Packer and David Schiff, covers the field broadly, with detail when needed and helpful pointers along the way. Overview chapters cover etiology, epidemiology, and diagnosis, followed by treatment overviews concerning surgery, radiation therapy, and chemotherapy and biologic agents. Chapters on specific topics follow, covering the major areas of neuro-oncology encountered in pediatric and adult practice. We hope this approach will appeal to students, trainees, experts, and practicing neurologists alike. The editors are expert in their field and have recruited superb contributors to share their views on best treatment and management options.

Chapters cover critical information that will inform the reader of the disease processes and mechanisms as a prelude to treatment planning. Algorithms and guidelines are presented, when appropriate. “Tips and Tricks” boxes provide expert suggestions. Other boxes present cautions and warnings to avoid pitfalls. Finally, we provide “Science Revisited” sections which review the most important and relevant science background material. Bibliographies guide the reader to additional material.

We welcome feedback. As additional volumes are added to the series, we hope to refine the content and format so that our readers will be best served.

Our thanks, appreciation, and respect goes out to our editors and their contributors, who conceived and refined the content for each volume, assuring a high quality, practical approach to neurologic conditions and their treatment.

And our thanks also go to our mentors and students (past, present, and future), who have challenged and delighted us; to our book editors and their contributors, who were willing to take on additional work for an educational goal; and to our publisher, Martin Sugden, for his ideas and support, for wonderful discussions, and for commiseration over baseball and soccer teams that might not quite have lived up to expectations. We would like to dedicate the series to Marsha, Jake, and Dan; and to Janet, Laura, and David. And to Steven R. Schwid, MD, our friend and colleague, whose ideas helped shape this project and whose humor brightened our lives, but who could not complete this goal with us.

Robert A. Gross

Jonathan W. Mink

Rochester, MN, USA

Preface

Neuro-oncology is a broad, ever-changing discipline, involving the specialties of neurology, neurosurgery, medical and pediatric oncology, radiation oncology, neuroradiology, and neuropathology, among others. Under its purview are the management of primary central nervous system tumors, the effects of systemic cancer on the nervous system, oncologic-related autoimmune conditions causing significant neurologic compromise, and the acute and long-term sequelae of oncologic treatment. For decades, the care of patients with primary central nervous system tumors was frustrating, with little progress being made. Recently there have been remarkable advances in the understanding of the molecular pathogenesis of cancer, the biology of neurodevelopment, basic mechanisms of cellular signaling, and how these all have a role in brain tumor development. Furthermore, there have been advances in the understanding of the mechanisms involved in paraneoplastic conditions and factors that predispose to treatment-related untoward effects on the adult and immature nervous systems. There has also been confirmation that tumors arising in children are molecularly different from those occurring in adults, and because of these molecular differences and the increased susceptibility of the developing nervous system to treatment-related injury, pediatric brain tumors require different management from those with similar histologies arising in adulthood.

While tremendous gains in molecular understanding of cancer in developing nervous system have not yet been widely translated into improved outcomes, innovative, biologically based approaches to treatment are rapidly being incorporated into management schema with the promise of better, less toxic therapy. This has given rise to the hope that “personalized” approaches to the treatment of brain tumors is within reach.

It is with this rapidly changing and maturing landscape that this volume in the series of Neurology in Practice has been developed. The textbook is not intended as an all-encompassing detailed reference, but rather as an easy-to-read, comprehensive text that covers the general aspects of therapy of adult and pediatric brain tumors, present concepts of the pathogenesis and management of the most common types of primary central nervous system tumors, and the effects of systemic cancer on the nervous system. Aspects of present management are emphasized while attempting to integrate newer concepts, especially biologic, which will soon have a direct impact on management and outcome of these lesions. Realizing the dynamic nature of the field, there was an attempt to move this text rapidly into press, so as not to be outdated at the time of publication. The neuro-oncology contribution to this series is designed to update both the academic and practicing neurologist and neurosurgeon, as well as physicians in practice and others caring for patients with brain tumors and cancers affecting the nervous system, with a readable review of all of the major types of tumors and a framework to understand new therapies, as they are being introduced. There is a purposeful emphasis on unique management approaches for adult and pediatric tumors where such distinctions are driven by the biology of the tumor or the effects of the required therapy on the developing nervous system. Although biases are unavoidable in such a complex field, there is every attempt, in this volume, to focus on evidence-based best practices.

Roger J. Packer, MD

Washington, DC, USA

David Schiff, MD

Charlottesville, VA, USA

Acknowledgments

I would like to thank David Schiff for his willingness to work with me on this text (I could not have had a better co-editor) and all of the authors for giving of their time and expertise. I want to thank the superb neuro-oncology team at Children’s National, including Brian Rood, Lindsay Kilburn, Eugene Hwang, Gilbert Vezina, and Elizabeth Wells, for their support. Over the years, Betsy Schaefer has provided tremendous editorial help and expertise, allowing me to complete this and other works. Lastly, and most importantly, I want to thank my family: Bashi, Michael, Zavi, Rachael, Ophir, and Anabel for their love and encouragement.

Roger J. Packer

I would like to thank Roger J. Packer for the opportunity to participate in this worthwhile endeavor and the individual chapter authors for their top-notch and timely contributions. The incredible neuro-oncology team at UVA, including B.J. Purow, Jennie Friend, Marcia Molnar, Gina Petersen, Jim Finn, Stacy Smith, Kristie Coles, and most importantly Bruce Leffler, helped me carve out the time to complete this project. Over many years, the love and support from Julie and Dick Leerburger, Evie Joss, and Datsie Adams among others has been invaluable. Last and most of all, thanks to Tanya, Jasper, and Gracie, who keep me smiling.

David Schiff

Part I: Overview and General Aspects of Therapy

1

Diagnosis of Brain Tumors: Clinical and Radiographic

Isabel C. Arrillaga-Romany Eudocia Quant Lee and Patrick Y. Wen

Center for Neuro-Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, USA

Introduction

Recent epidemiologic studies by the Central Brain Tumor Registry of the United States report the rate of symptomatic brain tumors at 19 per 100,000 person-years. An estimated 64,500 new cases of primary central nervous system (CNS) tumors and 150,000 cases of brain metastases are expected to be diagnosed in the United States in 2011. Surgery, chemotherapy, and radiation are the mainstays of therapy, and early diagnosis may produce better outcomes.

This chapter focuses on the diagnosis of tumors of the CNS and reviews both presenting clinical and neuroimaging features. Clinical recognition and imaging are essential early steps in identification of CNS tumors, although pathologic evaluation of tissue samples remains the gold standard for diagnosis. Rarely, when a biopsy is not feasible (for example with pediatric brainstem tumors), imaging has an even more valuable role. Our goal is to familiarize clinicians with general principles that are useful in the clinical recognition of potential brain tumors and to review imaging modalities that help differentiate brain tumors from other mass lesions.

Clinical Diagnosis of Brain Tumors

History

Diagnosis of CNS neoplasms begins with a good clinical history and examination. Both nonspecific and focal neurologic complaints and symptoms can alert the primary care physician or neurologist to the possibility of an underlying mass lesion and indicate the need for further work-up. Key aspects of the history that help differentiate neoplastic lesions from other diagnoses include timing of symptom onset, tempo of progression, and severity of symptoms. Systemic symptoms and the presence of other diseases or hereditary syndromes are additional valuable pieces of information that can help narrow the diagnosis by their association with specific CNS tumors.

Symptoms produced by brain tumors may be either nonspecific or focal, and in general tend to be subacute in onset. The presentation varies widely and neither a normal neurologic exam nor presentation with acute onset of symptoms rules out a brain tumor. At the outset many brain tumors produce minimal or no symptoms. In contrast, brain tumors can also present with acute onset stroke-like symptoms. This type of acute presentation is usually the result of a focal seizure or hemorrhage into the tumor bed. Less common causes include infarction or intraparenchymal hemorrhage resulting from stroke or venous sinus thrombosis, two conditions to which brain tumor patients are predisposed given their inherent hypercoagulable state.