Davis FG, Freels S, Grutsch
J, et al. Survival rates in patients with primary malignant brain tumors
stratified by patient age and tumor histological type: an analysis based
on Surveillance, Epidemiology, and End Results (SEER) data, 1973-1991.
J Neurosurg. 1998;88:1-10.
The largest epidemiological study of brain tumors,
sponsored by the Central Brain Tumor Registry of the United States (CBTRUS),
a sister organization of the American Brain Tumor Association (ABTA), contains
significant information on the current profile of primary malignant brain
tumors. The study of over 20,000 patients with brain tumors covers 18 years
during which the diagnosis and treatment of brain tumors evolved rapidly.
Considerable improvements in survival rates between the years of 1973 to
1980 and the more recent era of 1986 to 1991 were noted for children and
adults with medulloblastoma, as well as adults with astrocytoma (nonmalignant)
and oligodendroglioma. Glioblastoma multiforme continues to the most intractable
brain tumors with little improvement in survival despite dramatic advances
in diagnostic and surgical technology.
Gately S, Soff GA, Brem S.
The potential role of basic fibroblast growth factor in the transformation
of cultured primary human fetal astrocytes and the proliferation of human
glioma (U-87) cells. Neurosurgery. 1995;37:723-730.
The switch to the malignant phenotype may be linked
to the gene expression of specific oncogenes and growth factors. In animal
models and in vitro experiments, basic fibroblast growth factor
is linked with the proliferation, invasion, and angiogenesis response of
malignant brain tumor cells. These data support the development of pharmacological
compounds that suppress the expression or inhibit the action of these growth
factors.
Fernandez PM, Brem S. Malignant
brain tumors in the elderly. Clin Geriatr Med. 1997;13:327-338.
The increase in the incidence of primary brain tumors
in the elderly over the last decade represents a serious health problem.
Surgery remains the mainstay of the management of malignant gliomas, and
the extent of the resection is one factor linked to the length of survival.
This article reviews standard treatment modalities as well as novel approaches
in clinical trials to treat newly diagnosed and recurrent glioblastomas.
Brem S, Rozental JM, Moskal
JR. What is the etiology of human brain tumors? A report on the first Lebow
Conference. Cancer. 1995; 76:709-713.
The key to the optimal treatment of brain tumors
will be the clear understanding of the biological origins, preventable
factors, and specific control mechanisms. The puzzle of what causes
brain tumors remains complex with theories linking it to environmental
(eg, electromagnetic radiation), genetic, dietary, and hereditary factors.
The Lebow Conference, attended by prominent scientists and clinicians,
identified new avenues of research across multiple scientific disciplines.
Brem H, Piantadosi S, Burger
PC, et al. Placebo-controlled trial of safety and efficacy of intraoperative
controlled delivery by biodegradable polymers of chemotherapy for recurrent
gliomas. Lancet. 1995; 345:1008-1012.
This prospective, randomized, placebo-controlled,
multicenter trial of 222 patients is noteworthy because it reports a new
treatment that is safe and effective for recurrent malignant gliomas. The
study was conducted under rigorous control and opens the door for further
trials with more effective drugs.
Harbaugh KS, Black PM. Strategies
in the surgical management of malignant gliomas. Semin Surg Oncol.
1998;14:26-33.
This article reviews the current neurosurgical technology
including MRI guidance and stereotaxy to maximize the safe removal of the
brain tumor while sparing "eloquent" and vital areas of brain.
Fetell MR, Grossman SA, Fisher
JD, et al. Pre-irradiation paclitaxel in glioblastoma multiforme: efficacy,
pharmacology, and drug interactions. New Approaches to Brain Tumor Therapy
Central Nervous System Consortium. J Clin Oncol. 1997;15:3121-3128.
The plasma concentrations of paclitaxel in patients
taking enzyme-inducing antiepileptic drugs (eg, diphenylhydantoin, carbamazepine,
phenobarbital) were significantly lower than in patients not taking these
antiseizure medication. Thus, the concomitant administration of antiseizure
medication introduces an important variable in interpreting efficacy data,
pharmacokinetics, and toxicity of novel agents for treatment of brain tumors.
Lang FF, Sawaya R. Surgical
treatment of metastatic brain tumors. Semin Surg Oncol. 1998; 14:53-63.
This article provides a clear exposition of criteria
for selection of suitable candidates for surgery, emphasizing that multiple
or recurrent brain metastases can be successfully removed with an increase
in survival and enhancement of the quality of life, often complementing
other available modalities such as stereotactic radiosurgery and whole-brain
irradiation.
Jacobs W, Mikkelsen T, Smith
R, et al. Inhibitory effects of CAI in glioblastoma growth and invasion.
J Neurooncol. 1997;32:93-101.
CAI, carboxyamide-triazole, is an anticancer agent
developed as an inhibitor of selected signal transduction pathways. CAI
inhibits the invasive phenotype of human glioma cell lines and decreases
production of the 72kDa and 92 kDa type IV collagenases, thus suggesting
a potential for benefit in the treatment of high-grade astrocytomas.
Harsh GR 4th. Management of
recurrent gliomas and meningiomas. In: Kaye AH, Laws ER Jr, eds. Brain
Tumors: An Encyclopedic Approach. New York, NY: Churchill Livingstone;
1995:413-428.
This report represents a superb overview of the multimodality
treatment of gliomas in an outstanding reference source for the modern
approach to brain tumors.